THE USE OF SMALLER VERSUS LARGER BOUGIE IN SLEEVE GASTRECTOMY: A META-ANALYSIS.
Abdul-Rahman F. Diab*
Department of Surgery, USF Health Morsani College of Medicine, Tampa, FL
Introduction: One of the most debated issues in the practice of sleeve gastrectomy (SG) is the size of the bougie used during procedures. While larger size (50-Fr to 60-Fr) bougies initially used in SG are generally avoided these days, it has been suggested that the optimal size should be well below 40-Fr. The aim of this study was to compare the outcomes of choosing smaller versus larger bougies.
Methods: Literature search was done according to the PRISMA guidelines. 11 Observational cohort studies were included in the analysis. Meta-analysis was done using the RevMen 5.4.1 software. Statistical method used was Mantel-Haenszel. Analysis model used was random effects regardless of the heterogeneity (I2). The 11 studies compared different sets of sizes which is a limitation for this study. This study doesn't compare between specific sizes but compare between outcomes of choosing smaller versus larger bougies regardless of the exact sizes.
Results: Significant difference in favor of smaller bougies was observed in ED visit due to dehydration (OR 0.92, CI 0.86, 0.98), and in excess weight loss % (EWL%) at 12 months (MD 5.92, CI 1.73, 10.11). However, significant difference in favor of larger bougies was observed in postoperative leaks (OR 1.20, CI 1.08, 1.33). No significant difference was observed in length of stay (MD -0.36, CI -1.24, 0.52), readmissions (OR 0.96, CI 0.72, 1.28), reoperations (OR 0.98, CI 0.55, 1.72), luminal complications (stenosis, strictures, kinks, obstructions) (OR 0.91, CI 0.04, 11.89), surgical site occurrences (infection, abscess, hematoma) (OR 1.36, CI 0.41, 4.48), or total complications (OR 1.74, CI 0.78, 3.9).
Conclusion: Smaller bougies decrease ED visit due to dehydration and increase EWL% at 12 months. However, they increase the risk of leaks. Further studies are warrented.
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